Provider Demographics
NPI:1619507605
Name:APPLIED GERONTOLOGY, LLC
Entity Type:Organization
Organization Name:APPLIED GERONTOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERONTOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPG
Authorized Official - Phone:480-454-5674
Mailing Address - Street 1:2705 S ALMA SCHOOL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4400
Mailing Address - Country:US
Mailing Address - Phone:480-454-5674
Mailing Address - Fax:
Practice Address - Street 1:2705 S ALMA SCHOOL RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4400
Practice Address - Country:US
Practice Address - Phone:480-454-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care